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I am a person with diabetes type 2 and write about my experiences and research. Please discuss medical problems with your doctor. Please do not click on the advertisers that have attached to certain words in this section. They are not authorized and are robbing me by doing so.

January 14, 2015

Diabetes, Why Isn't Medicine Doing What It Should?

This was published in the British
Journal of Diabetes and Vascular Disease. Some of you might like to
read the article. In reading this, I have to wonder why the doctors
in the United States cannot do anything right. For this, I think
some of the blame belongs to the American Diabetes Association and
the American Association of Clinical Endocrinologists. More of the
blame belongs to the certified diabetes educators that do not
educate, but use mandates and mantras.

Most of the blame has to fall on our
medical insurance industry that listens to the Centers for Medicare
and Medicaid Services (CMS), especially now that the insurance
industry has learned how to sidestep the no prior exclusion part of
the Affordable Care Act, by almost monthly changing the formulary
from which they will reimburse for diabetes and other medications.
Some insurance companies are doing exactly this and as a result, many
people with diabetes are having a difficult time staying on one
medication that is doing well for them. Some of the better companies
are consistent in their formulary which is a good thing.

Diabetes care cannot prevent
complications in every patient, but surely, doctors could prevent
much of the tissue damage that happens in their patients' lives.
Unlike in England, here the electronic medical records (EMRs) are
very proprietary so that data on diabetes is impossible to obtain.
Presently there is not a government agency that can collect data on a
national basis to track diabetes and what works and what does not
work. These same government agencies rely on information provided on
a voluntary basis, which leaves gaping holes in the successes and
adverse events that happen with diabetes medications.

The information collection and sharing
needs to improve or more doctors will be leaving the practice of
medicine. Yet, with the government not staying ahead of the
progress, it could be another decade or more before EMRs become
usable for the benefit of all – government, health care providers,
and patients. Maybe then, the insurance industry will be forced into
compliance.

The United States medical system relies
on voluntary reporting for much of the data that the different
government agencies rely on and report to the public. They cannot
give accurate numbers of people at different ages with any type of
diabetes. They presently use algorithms for most reporting which
gives a very good estimate, but not an accurate number.

When people with diabetes are in the
hospital, care has been improving, but still too many errors happen.
The first is some nurses that don't understand the ratio for insulin
to grams of carbohydrates for each individual. Then many doctors
over use basal insulin and cause hypoglycemia. The other big problem
is that the food plan for people with diabetes that is promoted by
dietitians. It is overloaded with carbohydrates at a time our body
needs fat and protein to aid healing, but the dietitians will not
allow this.

I can understand that young doctors are
less likely to choose Diabetes and Endocrinology as a career. It is
a well-known fact that medical, nursing, and other healthcare
students have little training in diabetes. There are not enough
certified diabetes educators to serve the current diabetes population
and with the projected increase, there is little effort to train
more. One CDE organization says they are working on this, but when
everything is tied up in committee, who is to know what intentions
have priority. The other CDE organization is trying to put a
strangle hold on who can practice as a CDE. Both organizations work
with so few people with type 2 diabetes that I must wonder when they
will force their members to stay away from mandates and mantras and
start teaching diabetes education.

Until the Federal and State governments
start requiring insurance to cover telemedicine, little growth in
treating rural diabetes patients will happen. When I think of the
diabetes education that could be taught by a form of telemedicine, it
stinks that most healthcare providers will not use this. Then we
have other medical professions working to stop telemedicine through
state medical boards. This is protectionism rather than education at
its worst.

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About Me

I am enjoying life, despite diabetes type 2. I am retired and enjoying the time I have for writing and photography. I was diagnosed with type 2 on Oct 2003, on oral meds for 4 months and they were doing nothing to really improve my daily readings. By cutting my carbohydrates I received the most improvement, but still not enough. Then I requested insulin, even though I did not like the thought of needles. That brought about the biggest change and A1c's in the lower 6's and upper 5's. Now I am working at maintaining them under 6.0 and hopefully nearer 5.5.